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Circle of Life Prevention Curriculum for Youth

About the Program

Multimedia Circle of Life is a sexual risk-reduction program designed specifically for American Indian youth ages 10-12 years. Multimedia Circle of Life
teaches skills such as goal setting, decision making, and standing up to peer pressure. Prevention topics include: how diseases are spread; the health
effects of HIV, AIDS and sexually transmitted infections; and ways youth can protect themselves from these diseases. The content also addresses teen
pregnancy prevention.

Cultural Relevance

Cultural Alignment, Adaptation or Tailoring Process

Multimedia Circle of Life is the multimedia adaptation of Circle of Life, a sexual risk reduction program that was developed by ORBIS Associates, an
American Indian owned and operated company. Circle of Life was not an adaptation of an intervention used in another setting. It was developed from the
ground up with extensive input from American Indian community members, education experts and health professionals across the country. In 2010, the Office
of Minority Health Resource Center, the Indian Health Service HIV/AIDS Program and the Centers for American Indian and Alaska Native Health at the
University of Colorado partnered to adapt Circle of Life to a multimedia format. Since Circle of Life was found to be effective in delaying sexual activity
at young ages, the content was revised to be age appropriate for 10-12 year-olds.

Multimedia Circle of Life’s theoretical model is based on the Medicine Wheel, a Native American cultural symbol, and undergirded by behavioral theories
including Social Cognitive Theory, Theory of Reasoned Action, and Theory of Planned Behavior. The Medicine Wheel is divided into four equal parts,
representing the mental, physical, emotional and spiritual aspects of well-being. Youth learn that all people have volition, the power to make their own
decisions. Youth can stay healthy by using their volition to strengthen and balance their own Medicine Wheel. This strength helps them to empower
themselves and honor their families and communities.

Multimedia Circle of Life teaches skills such as goal setting, decision making and standing up to peer pressure. Prevention topics include how diseases are
spread, the health effects of HIV, AIDS and sexually transmitted infections, and ways in which youth can protect themselves from these diseases. With the
multimedia adaptation, the content was expanded to include new topics such as teen pregnancy prevention and hepatitis B and C. The online program has six
regionalized visual representations; each was created by a Native American artist and reflects each region’s unique artistic style and symbolism. So too,
the Multimedia Circle of Life logo was created by a Native American artist.

Multimedia Circle of Life contains seven chapters. To complete each chapter, youth go through the online lesson independently (about 20 minutes). In
addition, Multimedia Circle of Life includes a series of companion in-person activities for a group or class. Activities are interactive and include
discussions, instruction, demonstrations, games and crafts. Either component of the intervention can be presented alone, but combining online lessons with
in-person classes provide youth with opportunities to ask questions, discuss the online content and reinforce curriculum concepts.

Evaluation

Circle of Life was evaluated from 2006 to 2009 in a group-randomized controlled trial with 13 middle schools (youth ages ranged from 11 to 16 years at
baseline) in a Northern Plains tribal community. Results showed Circle of Life was effective for
delaying the onset of sexual activity among AI/AN youth who received the program when they were young adolescents compared to those who received it at
older ages or not at all.

With funding from the HHS Office of Adolescent Health, Multimedia Circle of Life was evaluated in a cluster randomized controlled design with 15 Native
Boys and Girls Clubs in the Northern Plains. At post-intervention and a 9-month follow-up, Multimedia Circle of Life was found to have effects on
precursors to sexual behavior, including self-efficacy and volition, which may lead to less risky sexual behavior in later years. Additionally, the program
was well received by club staff as important and easy to use, while most youth indicated they would recommend it to their friends.